Brain injury due to ventricular shunt placement delineated by diffusion tensor imaging (DTI) tractography

Objective: Infection and hemorrhage are well-known complications from insertion of intracranial shunts. However, permanent injury to the brain caused by catheterization of the cerebral ventricles has rarely been reported. Methods: We report a patient who presented at age 14 years for evaluation of a severe behavioral disorder. The patient had sustained direct injury to the corticospinal tract and limbic system during revision of a ventriculoperitoneal shunt at the age of 9 years. Results: Despite persistent evidence of severe disruption of the corticospinal tract on diffusion tensor imaging at age 14 years, the patient had regained complete motor function. Conclusion: Recovery of motor function after serious injury to motor cortex during childhood is a dramatic example of the plasticity of the child's brain to injury. In addition, we suggest that the behavioral disorder that emerged in this patient may be related to limbic system injury suffered during the shunt revision.